Sunday, September 30, 2012

Every day, thousands of polls, surveys, and rating
scales are employed to elicit the attitudes of humankind. Given the ubiquitous
use of these instruments, it seems we ought to have firm answers to what is
measured by them, but unfortunately we do not. To help remedy this situation,
we present a novel approach to investigate the nature of attitudes. We created
a self-transforming paper survey of moral opinions, covering both foundational
principles, and current dilemmas hotly debated in the media. This survey used a
magic trick to expose participants to a reversal of their previously stated
attitudes, allowing us to record whether they were prepared to endorse and
argue for the opposite view of what they had stated only moments ago. The
result showed that the majority of the reversals remained undetected, and a
full 69% of the participants failed to detect at least one of two changes. In
addition, participants often constructed coherent and unequivocal arguments
supporting the opposite of their original position. These results suggest a
dramatic potential for flexibility in our moral attitudes, and indicates a
clear role for self-attribution and post-hoc rationalization in attitude formation
and change.

Saturday, September 29, 2012

Over
the past decade, off-label use of antipsychotic drugs has increased among
children enrolled in Medicaid, according to a new study representing 35 percent
of children in the United States.

Off-label
drug use is a term used to describe when drugs are prescribed using a dosage,
type of dosage or for a purpose that hasn't yet been approved by the U.S. Food
and Drug Administration.

In
the study, researchers from the Children's Hospital of Philadelphia found a 62
percent jump in the number of publicly insured children between the ages of 3
and 18 taking antipsychotics. In 2007 alone, 65 percent of the 354,000 children
on these drugs were taking them for uses that have not been approved by the
FDA, the investigators pointed out.

"We
knew that the number of children prescribed antipsychotics had grown steadily
over the past two decades, particularly among children with public
insurance," study author Meredith Matone, a researcher at PolicyLab, said
in a hospital news release. "With this study, we wanted to learn more
about why these drugs are being used so often, what diagnoses they're being
used to treat, and how prescribing patterns changed over the course of the last
decade."

Friday, September 28, 2012

By Merrill Goozner
The Fiscal Times
Originally published September 19, 2012

Obesity rates have doubled over the past two decades and will almost double again over the next two decades unless the public comes to grips with its swelling waistlines, a new study says.

The rising tide of obesity threatens to send health care costs soaring. Already, the nation spends an estimated $147 billion to $210 billion per year on obesity-related diseases including Type 2 diabetes, hypertension, heart disease, and arthritis. Unless the projections are altered dramatically, additional medical costs associated with treating preventable, obesity-related diseases could swell by another $48 billion to $66 billion by 2030, the report said.

“We have this middle-aged cohort who are obese today and in the next 10 to 20 years will become quite costly,” said Jeffrey Levi, executive director of Trust for America’s Health, which co-authored the report with the Robert Wood Johnson Foundation. “They’re the really tough nuts to crack when it comes to combating obesity.”

Addressing the obesity epidemic by preventing excess calorie consumption with government regulation of portion sizes is justifiable and could be an effective measure to help prevent obesity-related health problems and deaths, according to a Viewpoint in the September 19 issue of JAMA, and theme issue on obesity.

Thomas A. Farley, M.D., M.P.H., Commissioner of the New York City Department of Health and Mental Hygiene, presented the article at a JAMA media briefing.

"Americans consume many more calories than needed, and the excess is leading to diabetes, cardiovascular disease, and premature mortality. Since the 1970s, caloric intake has increased by some 200 to 600 calories per person per day. Although it is unclear how important changes in physical activity are to the surge in obesity prevalence, it is quite clear that this increase in calorie consumption is the major cause of the obesity epidemic—an epidemic that each year is responsible for the deaths of more than 100,000 Americans and accounts for nearly $150 billion in health care costs," writes Dr. Farley.

Thursday, September 27, 2012

By David Pittman
MedPage Today
Originally published September 17, 2012

The U.S. Defense Department needs
more providers trained in treating substance abuse in the armed forces,
according to an Institute of Medicine report.

The prevalence of comorbid
behavioral conditions "necessitates access to providers with advanced
levels of training rather than certified counselors or peer support by
individuals in recovery," the report, released Monday, read.

The Department of Defense (DOD)
asked the IOM to assess the way it handles the prevention, screening,
diagnosis, and treatment of substance use disorders (SUDs) for service members,
National Guard troops, members of the Reserves, and military dependents.

IOM researchers held public
information gathering meetings, conducted five site visits to military bases to
meet with primary care and behavioral health providers, and received information
and data on services from the military.

(cut)

Specifically, the IOM found:

Shortages of SUDs counselors across
all branches

Wide variation in training and
credentialing requirements for counselors across the branches

Wednesday, September 26, 2012

Johnson and Johnson agreed to a last-minute settlement of a lawsuit claiming that a boy's use of its antipsychotic drug Risperdal caused abnormal breast growth.

The settlement—whose terms were confidential—averted a civil trial scheduled to begin Monday in which plaintiffs' lawyers intended to summon J&J Chief Executive Alex Gorsky as a witness. Mr. Gorsky previously held leadership roles at the J&J division responsible for marketing Risperdal during the period when the boy's alleged injury occurred.

Robert C. Hilliard, an attorney for the plaintiff, told a judge in the Philadelphia Court of Common Pleas Monday "this case has reached a final resolution." He said the settlement amount was confidential.

Tuesday, September 25, 2012

For those who have followed this blog, powered by Blogger.com (a Google product), the last several days have likely appeared normal. Behind the curtain, there have been some difficulties.

Since September 18, 2012, the Ethics Education and Psychology Blog (along with likely all Blogger.com blogs) has been experiencing problems. The most visible to readers is the possibility that someone attempted to sign up for email services without success.

If you have attempted to sign up for email subscription services from September 18 through the 25th, 2012, then you likely are not receiving email from Ethics Education and Psychology.

I apologize, in advance, for any inconvenience. If you attempted to sign up for email between these dates, then you will need to do so again. Apparently, Google was in the midst of changing templates and the email subscription services (among others) had been temporarily interrupted.

Thank you for following the blog.

Special thanks to those who send notes about news stories, PowerPoint presentations, and other blog-worthy information.

High-profile cases and modern technology are putting scientific deceit under the microscope

By Alok Jha

The Guardian

Originally published September 13, 2012

Dirk Smeesters had spent several years of his career as a social psychologist at Erasmus University in Rotterdam studying how consumers behaved in different situations. Did colour have an effect on what they bought? How did death-related stories in the media affect how people picked products? And was it better to use supermodels in cosmetics adverts than average-looking women?

The questions are certainly intriguing, but unfortunately for anyone wanting truthful answers, some of Smeesters' work turned out to be fraudulent. The psychologist, who admitted "massaging" the data in some of his papers, resigned from his position in June after being investigated by his university, which had been tipped off by Uri Simonsohn from the University of Pennsylvania in Philadelphia. Simonsohn carried out an independent analysis of the data and was suspicious of how perfect many of Smeesters' results seemed when, statistically speaking, there should have been more variation in his measurements.

The case, which led to two scientific papers being retracted, came on the heels of an even bigger fraud, uncovered last year, perpetrated by the Dutch psychologist Diederik Stapel. He was found to have fabricated data for years and published it in at least 30 peer-reviewed papers, including a report in the journal Science about how untidy environments may encourage discrimination.

Monday, September 24, 2012

Mental health professionals, who often are tasked with evaluating and managing the risk of violence by their patients, may benefit from a simple tool to more accurately make a risk assessment, according to a recent study conducted at the University of California, San Francisco.

The research, led by psychiatrist Alan Teo, MD, when he was a UCSF medical resident, examined how accurate psychiatrists were at evaluating risk of violence by acutely ill patients admitted to psychiatric units.

(cut)

The first part of the study showed that inexperienced psychiatric residents performed no better than they would have by chance, whereas veteran psychiatrists were moderately successful in evaluating their patients' risk of violence.

However, the second part of the study showed that when researchers applied the information from the "Historical, Clinical, Risk Management?-Clinical" (HRC-20-C) scale - a brief, structured risk assessment tool - to the patients evaluated by residents, accuracy in identifying their potential for violence increased to a level nearly as high as the faculty psychiatrists', who had an average of 15 years more experience.

"Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained mental health professional can use to assess their patients," Teo said.

"To improve the safety for staff and patients in high-risk settings, it is critical to teach budding psychiatrists and other mental health professionals how to use a practical tool such as this one."

Sunday, September 23, 2012

By David CraryThe Associated PressOriginally published on September 16, 2012They are images Americans had never seen before. Jubilant young men and women in military uniforms marching beneath a rainbow flag in a gay-pride parade. Soldiers and sailors returning from deployment and, in time-honored tradition, embracing their beloved — only this time with same-sex kisses.

It's been a year now since the policy known as "don't ask, don't tell" was repealed, enabling gay and lesbian members of the military to serve openly, no longer forced to lie and keep their personal lives under wraps.

The Pentagon says repeal has gone smoothly, with no adverse effect on morale, recruitment or readiness. President Barack Obama cites it as a signature achievement of his first term, and his Republican challenger, Mitt Romney, says he would not push to reverse the change if elected in place of Obama.

Some critics persist with complaints that repeal has infringed on service members whose religious faiths condemn homosexuality. Instances of anti-gay harassment have not ended. And activists are frustrated that gay and lesbian military families don't yet enjoy the benefits and services extended to other military families.

Yet the clear consensus is that repeal has produced far more joy and relief than dismay and indignation. There's vivid evidence in photographs that have rocketed across cyberspace, such as the military contingent marching in San Diego's gay pride parade and Marine Sgt. Brandon Morgan leaping into the arms of his boyfriend after returning from six months in Afghanistan.

Saturday, September 22, 2012

By Richard Perez-PenaThe New York Times
Originally published September 7, 2012

Large-scale cheating has been uncovered over the last year at some of the nation’s most competitive schools, like Stuyvesant High School in Manhattan, the Air Force Academy and, most recently, Harvard.

Studies of student behavior and attitudes show that a majority of students violate standards of academic integrity to some degree, and that high achievers are just as likely to do it as others. Moreover, there is evidence that the problem has worsened over the last few decades.

Experts say the reasons are relatively simple: Cheating has become easier and more widely tolerated, and both schools and parents have failed to give students strong, repetitive messages about what is allowed and what is prohibited.

“I don’t think there’s any question that students have become more competitive, under more pressure, and, as a result, tend to excuse more from themselves and other students, and that’s abetted by the adults around them,” said Donald L. McCabe, a professor at the Rutgers University Business School, and a leading researcher on cheating.

Friday, September 21, 2012

Maine Attorney General Press Release
Originally published August 31, 2012

Attorney General William J. Schneider announced today that former psychologist John A. Keefe, 60, of Veazie, pled guilty to one count of Class B theft by deception and one count of Class C gross sexual assault for engaging in sexual acts with a client and billing MaineCare for mental health therapy services for that client.

Penobscot County Superior Court Justice William R. Anderson sentenced Keefe on each count to three years imprisonment with all but 120 days suspended and two years of probation, to be served concurrently. He also required Keefe to pay $14,806.52 restitution to MaineCare.

From 2007 to 2010, Keefe engaged in sexual acts with a female client while claiming to provide mental health therapy to that client. Some of the sexual acts occurred in Keefe’s office at Columbia Psychology Associates in Bangor during mental health therapy sessions that he billed to MaineCare. On June 22, 2010, Keefe surrendered his license to practice psychology during the pendency of the criminal action through entry of a consent agreement with the Maine Board of Examiners of Psychologists.

Thursday, September 20, 2012

By Annie LowreyThe New York Times
Originally published on September 11, 2012

The American medical system squanders 30 cents of every dollar spent on health care, according to new calculations by the respected Institute of Medicine. But in all that waste and misuse, policy experts and economists see a significant opportunity — a way to curb runaway health spending, to improve medical outcomes and even to put the economy on sounder footing.

“Everybody from Paul Krugman to Paul Ryan agrees it is essential to restrain costs,” said Dr. Mark D. Smith, the president of the California HealthCare Foundation and the chairman of the committee that wrote the report, referring to the liberal economist and Op-Ed columnist for The New York Times, and the conservative Wisconsin congressman who is Mitt Romney’s vice-presidential running mate. “The health care industry agrees, too.”

The Institute of Medicine report — its research led by 18 best-of-class clinicians, policy experts and business leaders — details how the American medical system wastes an estimated $750 billion a year while failing to deliver reliable, top-notch care. That is roughly equivalent to the annual cost of health coverage for 150 million workers, or the budget of the Defense Department, or the 2008 bank bailout.

Wednesday, September 19, 2012

During the last three decades, the United States has become more racially and ethnically diverse. We examine this trend at the local level, where the consequences of increased diversity for the economy, education, and politics regularly prompt debate, if not rancor. Decennial census and ACS data spanning the 1980-2010 period allow us to determine (a) the pervasiveness of diversity across America, focusing on metropolitan, micropolitan, and rural areas and places, and (b) the community characteristics that correlate with diversity.

We nd that almost all communities—whether large immigrant gateways or small towns in the nation’s heartland—have grown more diverse. However, the data show a wide range of diversity proles, from predominantly white communities (a shrinking number) to minority-majority and no-majority ones (an increasing number). The pace of local diversity gains, as well as shifts in racial-ethnic composition, has similarly varied.

While surging Hispanic and Asian populations often drive these patterns, other groups, including African immigrants, Native Americans, and multi-racial individuals, contribute to the distinctive mixes evident from one community to the next.

As for the correlates of diversity, communities with large populations, abundant rental housing, and a range of jobs are more diverse. So are those where the government and/or the military is a key employer. Locationally,diversity tends to be higher in coastal regions and along the southern border.

In short, a growing number of Americans now live in communities where multiple groups—Hispanics, blacks, and Asians as well as whites—are present in signicant proportions.

Prosecutors appealed to the N.H. Supreme Court, which reversed the decision in a ruling released Wednesday.

Hollenbeck was accused of engaging in sexual conduct with the woman less than a year after her therapy with him ended, which violates state law, according to court documents.

(cut)

In its 3-1 decision Wednesday, the N.H. Supreme Court said the state has a legitimate interest in protecting people whose ability to consent to sexual contact may be compromised by the inherent nature of the treatment relationship, and in maintaining the integrity of mental health professionals.

Monday, September 17, 2012

Before Gov. John Kitzhaber of Oregon established a moratorium on his state’s death penalty last year, Christian Longo, a death row inmate, started a campaign to allow the condemned to donate their organs.

Mr. Longo argued that a new execution protocol that many states — including Texas — have adopted leaves inmates’ organs viable for transplantation.

“While I can potentially help in saving one life with a kidney donation now, one preplanned execution can additionally save from 6 to 10 more lives,” Mr. Longo wrote in a plea that Oregon officials denied.

No state allows death row inmates to donate their organs. Although Texas recently abandoned a three-drug cocktail in favor of a single-drug method for execution, the Texas Department of Criminal Justice said it did not intend to change its policy.

Sunday, September 16, 2012

The influential Institute of Medicine has completed a comprehensive review of the nation's health care system, and here's the frightening diagnosis: Nearly $750 billion a year is wasted on unnecessary care, excessive administrative costs, fraud, duplication and poor communication.

The institute's conclusions may not be surprising to anyone who has had to reschedule an appointment because tests results were not available or to repeat a procedure in order to get accurate data. In fact, the group's study found that 20 percent of patients experienced the former and 25 percent the latter.

As many as a quarter of U.S. Medicare recipients spend more than the total value of their assets on out-of-pocket health care expenses during the last five years of their lives, according to researchers at Mount Sinai School of Medicine. They found that 43 percent of Medicare recipients spend more than their total assets minus the value of their primary residences.

The findings appear online in the current issue of the Journal of General Internal Medicine.

The amount of spending varied with the patient's illness. Those with dementia or Alzheimer's disease spent the most for health care, averaging $66,155, or more than twice that of patients with gastrointestinal disease or cancer, who spent an average of $31,069. Dementia patients often require special living arrangements, which accounts for the sizeable difference in cost.

Saturday, September 15, 2012

By Allie GrasgreenInside Higher Ed
Originally published September 6, 2012

Officials at Harvard University were quick to condemn the behavior of the 125 students suspected of collaborating inappropriately on a take-home exam.

“These allegations, if proven, represent totally unacceptable behavior that betrays the trust upon which intellectual inquiry at Harvard depends,” Harvard President Drew Faust said in a statement.

Harvard officials, who declined to comment for this story, say they plan to revisit their academic integrity policies and possibly create an honor code. It’s not the first time they’ve raised the idea – for at least two years now, administrators have recognized the potential need for a makeover. In 2010, undergraduate dean Jay Harris told The Harvard Crimson that academic dishonesty there was “a real problem.”

Harvard's official handbook says students should “assume that collaboration in the completion of assignments is prohibited unless explicitly permitted by the instructor.” And the university apparently created a voluntary academic integrity pledge students could sign last year, the Globe reported, but scrapped it this year.

Objective Although clinical training programs aspire to develop competency in violence risk assessment, little research has examined whether level of training is associated with the accuracy of clinicians’ evaluations of violence potential. This is the first study to compare the accuracy of risk assessments by experienced psychiatrists with those performed by psychiatric residents. It also examined the potential of a structured decision support tool to improve residents’ risk assessments.

Methods The study used a retrospective case-control design. Medical records were reviewed for 151 patients who assaulted staff at a county hospital and 150 comparison patients. At admission, violence risk assessments had been completed by psychiatric residents (N=38) for 52 patients and by attending psychiatrists (N=41) for 249 patients. Trained research clinicians, who were blind to whether patients later became violent, coded information available at hospital admission by using a structured risk assessment tool—the Historical, Clinical, Risk Management–20 clinical subscale (HCR-20-C).

Results Receiver operating characteristic analyses showed that clinical estimates of violence risk by attending psychiatrists had significantly higher predictive validity than those of psychiatric residents. Risk assessments by attending psychiatrists were moderately accurate (area under the curve [AUC]=.70), whereas assessments by residents were no better than chance (AUC=.52). Incremental validity analyses showed that addition of information from the HCR-20-C had the potential to improve the accuracy of risk assessments by residents to a level (AUC=.67) close to that of attending psychiatrists.

Conclusions Having less training and experience was associated with inaccurate violence risk assessment. Structured methods hold promise for improving training in risk assessment for violence.

Thursday, September 13, 2012

President Obama issued an executive order Friday tasking the Department of Veterans Affairs to expand its suicide prevention and mental health services.

Under the order, VA is expected to increase its veteran crisis line by 50 percent by the end of the year; ensure that a veteran in distress is given access to a trained mental health worker in 24 hours or less; and launch a national 12-month suicide prevention campaign to educate veterans about available mental health services.The order reinforces some initiatives that VA has already undertaken.

In April, VA announced that it would hire 1,600 mental health clinicians to meet surging demand, and the order instructs the agency to use loan repayment programs and scholarships, among other strategies, to recruit those professionals by June 2013.

A new nationwide strategy to prevent suicides, especially among U.S. military veterans and younger Americans, is tapping into Facebook, mobile apps and other technologies as part of a community-driven push to report concerns before someone takes his own life.

(cut)

The initiative includes $55.6 million in grant funding for suicide prevention programs.

Suicide is a growing concern and results in the deaths of more than twice as many people on average as homicide, officials said.

On average, about 100 Americans die each day from suicide, officials said. More than 8 million U.S. adults seriously thought about suicide in the last year, according to the Substance Abuse and Mental Health Services Administration.

Wednesday, September 12, 2012

By Scott JaschikInside Higher Ed
Originally published September 4, 2012

The gay alumni group at Franciscan University of Steubenville last week tried to draw attention to a course it views as anti-gay, and ended up embroiled in disputes not only over that course but over the group's right to link itself to the university in a public way.

Franciscan is a university that prides itself on strict adherence to Roman Catholic teachings, and the alumni group has no official connection to the university. But it has called itself, based on its members and their affiliations, Franciscan University Gay Alumni and Allies. Under that name, the group last week issued a news release questioning why the university offers a course that links homosexuality with forms of deviant behavior.

The course description, pulled from the university's catalog, states: "DEVIANT BEHAVIOR focuses on the sociological theories of deviant behavior such as strain theory, differential association theory, labeling theory, and phenomenological theory. The behaviors that are primarily examined are murder, rape, robbery, prostitution, homosexuality, mental illness, and drug use. The course focuses on structural conditions in society that potentially play a role in influencing deviant behavior."

By Carolyn Y. JohnsonBoston Globe
Originally published September 5, 2012

Marc Hauser, a prolific scientist and popular psychology professor who last summer resigned from Harvard University, had fabricated data, manipulated results in multiple experiments, and described how studies were conducted in factually incorrect ways, according to the findings of a federal research oversight agency posted online Wednesday.

The report provides the greatest insight yet into the problems that triggered a three-year internal university investigation that concluded in 2010 that Hauser, a star professor and public intellectual, had committed eight instances of scientific misconduct. The document, which will be published in the Federal Register Thursday, found six cases in which Hauser engaged in research misconduct in work supported by the National Institutes of Health. One paper was retracted and two were corrected, and other problems were found in unpublished work.

Although Hauser “neither admits nor denies committing research misconduct,” he does, the report states, accept that federal authorities “found evidence of research misconduct.”

Tuesday, September 11, 2012

A psychiatrist is not immune from being sued for damages by the family of a teenage inmate who killed himself in prison, a federal appeals court has ruled.

(cut)

The lawsuit stems from the March 2007 suicide of 19-year-old Timothy Hughes, who hanged himself from his bunk with a sheet in Butler County Prison after a social worker at the facility denied him access to Tepe to talk about his depression, history of suicide attempts and medication needs, according to the lawsuit.

On May 23, 2012, the Indiana Professional Licensing Agency State Psychology Board issued a complaint against psychologist Pamela Christy, Ph.D., citing conduct which indicates that she has become unfit to practice due to her failure to keep abreast of current professional theory or practice.(cut)Christy informed Patient A of this and also cited in a letter to the Board that she would only release the records with the daughters’ permission and that “Patient A believes that he can make that decision for his children merely because they are under the age of 18…. I see no such distinction in the law” and even if there were a such a provision, “Patient A is still not entitled to the information.

Christy however was wrong. Indiana Code § 16-39-2-9(b)(1) states that a noncustodial parent has equal access to the minor child’s mental health records as the custodial parent.

Monday, September 10, 2012

In a press release today, Cancer Care Group (Indianapolis, IN) announced that a laptop computer containing its computer server backup media was stolen from an employee’s locked care on July 19, 2012. The breach has potentially exposed the protected health information (PHI) or personally identifiable information (PII) of close to 55,000 individuals, including the organization’s own employees. The latest incident comes less than a month after Apria Healthcare reported a similar incident in Arizona where an employee’s car was broken into and a laptop containing information for 11,000 patients stolen.

Sunday, September 9, 2012

By John Ingold and Jeremy P. Meyerdenverpost.com
Originally published August 30, 2012

Here are some excerpts:

On the day she last saw James Holmes, University of Colorado psychiatrist Lynne Fenton went to a campus police officer with concerns about a patient.

Fenton testified Thursday during a hearing in Holmes' murder case that she had no contact with Holmes after June 11. That same day, Fenton said, she contacted Officer Lynn Whitten about a patient. Fenton did not identify the patient, citing the confidentiality issues that were the focus of Thursday's hearing.

"I was trying to gather information for myself," Fenton said.

(cut)

The purpose of the hearing was for prosecutors and defense attorneys to debate whether a notebook Holmes mailed to Fenton the day before the July 20 rampage, which also left 58 injured, is a confidential communication between a doctor and a patient. The defense says it is. Prosecutors believe they should be able to look at it.

The hearing ended Thursday unfinished, and the issue will be taken up again Sept. 20.

By Katie ThomasThe New York Times - Business Day
Originally published August 30, 2012

Johnson & Johnson announced Thursday that its pharmaceutical unit had reached a $181 million consumer fraud settlement with 36 states and the District of Columbia over its marketing of Risperdal, an antipsychotic drug.

The company’s pharmaceuticals subsidiary, Janssen, has been under scrutiny for years over its promotion of Risperdal, which treats symptoms of bipolar mania and schizophrenia. State and federal authorities have said that Janssen promoted the drug for uses it did not have approval for, including dementia in elderly patients, bipolar disorder in children and adolescents, depression and anxiety. Prosecutors have also accused the company of minimizing or concealing the risks associated with the drug.

In resolving the allegations by the states, Janssen did not admit wrongdoing or that it violated the law and said it settled to avoid “unnecessary expense and a prolonged legal process.”

Saturday, September 8, 2012

New York Times Letter to the Editor
Originally published September 3, 2012

To the Editor:

Re “Overtreatment Is Taking a Harmful Toll” (Well, Aug. 28): Undertreatment could be a much bigger problem than overtreatment. Studies by the RAND Institute, published in The New England Journal of Medicine, have found significant underuse of preventive testing and treatment for cervical, breast and colorectal cancer, as well as for H.I.V., heart disease and diabetes. RAND concluded that, on average, Americans receive only 55 percent of recommended preventive care and that underuse of such care was a bigger problem than overuse.

Alan Mertz

Washington

The writer is president, American Clinical Laboratory Association.

♦

To the Editor:

The overwhelming medical care in this country is actually appropriate. By emphasizing the bad experiences of a few, this article may end up suggesting to people that they should not trust their doctors.

Defensive medicine is sometimes practiced for fear of malpractice suits, but this should not be confused with the honest effort of the overwhelming majority of physicians to give their patients the best care possible.

Re “A Reluctant Crash Course in Health Insurance 101” (The Agenda, Aug. 21): Suleika Jaouad’s dispassionate account of the added burdens imposed by our fragmented system of health insurance on those unfortunate individuals who become sick is powerful in its lack of sentimentality. With an unconscionable 45,000 excess deaths a year due to lack of health insurance, we remain the only country in the world where getting seriously ill or hurt, as if that weren’t bad enough, significantly increases one’s risk for financial ruin — even with health insurance. More than half of personal bankruptcies in the United States result from medical bills, and of those, 75 percent of the cases are people who had medical insurance when they got sick or injured.

Until the for-profit health insurance industry is replaced by a single-payer national health insurance program, Americans will continue to suffer and die for the sake of excessive corporate salaries and shareholder profits.

Friday, September 7, 2012

Patients who sign up for trials testing more than one already approved intervention do not always know if one is being tested for harmful side effects

By Katherine HarmonScientific American
Originally published August 23, 2012

Here is an excerpt:

What you might not know—even after you sign up for the trial and have inked the informed-consent form—is that scattered reports are starting to suggest that the new medication might occasionally cause severe side effects. And the real reason the trial is being conducted with these previously released drugs is to test whether the new medication really is a lot riskier to everyone or just to a subset of patients.

If you found that out, would you still sign up for the trial? The problem is that many patients—and often even the institutional review boards that approve the trials—are never informed of these lingering questions.

This is one of the big ethical holes often left open in post-market trials, says Ruth Faden, director of the Johns Hopkins Berman Institute of Bioethics, who co-authored a new essay on this topic in TheNew England Journal of Medicine, which was published online August 22. She and a team of co-authors released a formal Institute of Medicine (IOM) report earlier this year recommending that the FDA improve this and other ethical aspects of post-market trials—especially those it requires.

Although the approval of a new drug is based on evidence that its benefits outweigh its risks, the full range of a medication's effects may not become apparent until a product has been used by a larger, more diverse population over an extended period of time. Problems associated with the anti-diabetes drug Avandia, pain reliever Vioxx, and cholesterol-reducing drug Crestor illustrate the challenges and underscore the need for a more systematic and transparent process to collect, assess, and act on data about a medication's benefit-risk profile throughout its entire "life cycle" from approval until it is no longer marketed, says a new report by the Institute of Medicine.

According to recent estimates, nearly half of all Americans take at least one prescription drug daily and many older people use five or more, noted the committee that wrote the report. The report's recommendations build on the new authorities and tools provided to the U.S. Food and Drug Administration through the Food and Drug Administration Amendments Act of 2007, which increased the agency's capacity to monitor drugs after approval and act if signs of safety problems appear.

One of the committee's key recommendations is that FDA should create a benefit and risk assessment and management plan for each drug. This would be a single, comprehensive, publicly available document that serves as a central repository of information for each product from its approval throughout its entire time on the market. The document should include a description of any safety questions that exist when a drug is approved or that emerge over the course of the product's use, as well as benefit and risk assessments specific to these questions. It should also include details on regulatory actions taken on the medication, such as restrictions on its use or the decision to require further research, as well as the results of these actions. Much of this information is already being gathered by FDA, but it is currently scattered across multiple records. Putting the information into an accessible format in a single document would make FDA's commitment to the life-cycle approach concrete and improve its transparency by giving the public easier access to useful data.

Thursday, September 6, 2012

In a large corpus of American books, we tracked how frequently words related to moral excellence and virtue appeared over the 20th century. Considering the well-established cultural trend in the United States toward greater individualism and its implications for the moral domain, we predicted that morality and virtue terms would appear with diminishing frequency in American books. Two studies supported our predictions: Study 1 showed a decline in the use of general moral terms such as virtue, decency, and conscience throughout the 20th century. In Study 2, we examined the appearance frequency of 50 virtue words (e.g., honesty, patience, compassion) and found a significant decline for 74% of them. Overall, our findings suggest that during the 20th century, moral ideals and virtues have largely waned from the public conversation.

Harvard University is investigating 125 students accused of collaborating on a spring take-home final exam, in what could prove to be the largest Ivy League cheating scandal in recent memory.

Nearly half the students in an introductory government class are suspected of jointly coming up with answers or copying off one another. Groups of students appear to have worked together on responses to short questions and an essay assignment, violating a no-collaboration policy that was printed on the exam itself, said Jay Harris, Harvard’s dean of undergraduate education.

Although no students appear to have lifted text from outside sources, some apparently plagiarized their classmates’ work, submitting answers that were either identical or “too close for comfort,” Harris said Thursday.

A teaching fellow noticed the similarities in May while grading a subset of the exams. He alerted the professor, who approached the college’s Administrative Board, the body that oversees student behavior. The board was worried enough to spend the summer interviewing some of the students and reviewing every exam in the class.

The students whose tests were flagged as problematic — nearly 2 percent of the college’s approximately 6,700 undergraduates — have been notified and will appear before the board individually in the next few weeks, Harris said. Some may be exonerated, but those found guilty could face a range of punishments up to yearlong suspensions.

Wednesday, September 5, 2012

Dr. Thomas is a psychologist who is a part owner of a private practice in which they offer Employee Assistance Program (EAP) services. The EAP service provides a solution-focused, three-session benefit for companies within Pennsylvania. Dr. Thomas normally does not handle EAP services. Several staff members were either ill or overbooked, so Dr. Thomas responds to EAP requests during the day.

When dealing with the EAP program, she thinks her title of “doctor” might put people off, so she announces herself as “Sue” when dealing with EAP clients. When returning a call from Chuck who works for a company with the EAP benefit, the psychologist indicates that she is "Sue" from the EAP program. Chuck is a 20-year old man who immediately expresses a great deal of agitation and anger. He complains loudly about his parents and his girlfriend. In the process of conversation, Dr. Thomas realizes that Chuck is the son of her next-door neighbors. While Chuck now lives in an apartment in town, she remembers him well. She actually attended his graduation party briefly and hired him to cut her lawn for two years.

Also during the course of the phone contact, Chuck expresses some homicidal rage toward his parents, particularly around financial issues and early childhood sexual abuse from his father. Dr. Thomas wants him to come in immediately for a more in-depth evaluation. Chuck hesitated to have a face-to-face interview at the practice, but agreed only if he can talk with Sue. Sue schedules the appointment for early in the evening.

What are the ethical concerns in this scenario?

How would you advise Dr. Thomas to handle them?

If you were a co-owner of the business, how would you feel about this situation?

Tuesday, September 4, 2012

By Tara Parker-Pope
The New York Times - The Well Column
Originally published August 27, 2012

When it comes to medical care, many patients and doctors believe more is better.

But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.

“Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone.”

Monday, September 3, 2012

A prominent Catholic friar has apologized for saying that child victims of sex abuse may at times bear some of the responsibility for the attacks because they can seduce their assailants, and that first-time sex offenders should not receive jail time.

"I did not intend to blame the victim," the Rev. Benedict Groeschel, of the Franciscan Friars of the Renewal, said Thursday. "A priest (or anyone else) who abuses a minor is always wrong and is always responsible."

As founder of the Trinity Retreat House, which operates "to provide spiritual direction and retreats for clergy," Groeschel has worked with priests involved in abuse.

His initial comments were published by the National Catholic Register, a conservative Christian publication, which also issued an apology.

"Child sexual abuse is never excusable," the newspaper said in a statement. "The editors of the National Catholic Register apologize for publishing without clarification or challenge Father Benedict Groeschel's comments that seem to suggest that the child is somehow responsible for abuse. Nothing could be further from the truth."

By Sharon OttermanThe New York Times
Originally published August 30, 2012

A prominent Roman Catholic spiritual leader who has spent decades counseling wayward priests for the archdiocese provoked shock and outrage on Thursday as word spread of a recent interview he did with a Catholic newspaper during which he said that “youngsters” were often to blame when priests sexually abused them and that priests should not be jailed for such abuse on their first offense.

The Rev. Benedict Groeschel, who made the remarks, is a beloved figure among many Catholics and a founder of Franciscan Friars of the Renewal, a conservative priestly order based in New York. He hosts a weekly show on the Eternal Word Television Network and has written 45 books.

The comments were published on Monday by The National Catholic Register, which is owned by EWTN, a religious broadcaster based in Alabama.

“Suppose you have a man having a nervous breakdown, and a youngster comes after him,” Father Groeschel, now 79, said in the interview. “A lot of the cases, the youngster — 14, 16, 18 — is the seducer.”

He added that he was “inclined to think” that priests who were first-time abusers should not be jailed because “their intention was not committing a crime.”

Sunday, September 2, 2012

Dr. Arul Chinnaiyan stared at a printout of gene sequences from a man with cancer, a subject in one of his studies. There, along with the man’s cancer genes, was something unexpected — genes of the virus that causes AIDS.

It could have been a sign that the man was infected with H.I.V.; the only way to tell was further testing. But Dr. Chinnaiyan, who leads the Center for Translational Pathology at the University of Michigan, was not able to suggest that to the patient, who had donated his cells on the condition that he remain anonymous.

In laboratories around the world, genetic researchers using tools that are ever more sophisticated to peer into the DNA of cells are increasingly finding things they were not looking for, including information that could make a big difference to an anonymous donor.

The question of how, when and whether to return genetic results to study subjects or their families “is one of the thorniest current challenges in clinical research,” said Dr. Francis Collins, the director of the National Institutes of Health. “We are living in an awkward interval where our ability to capture the information often exceeds our ability to know what to do with it.”

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Such ethical quandaries grow more immediate year by year as genome sequencing gets cheaper and easier. More studies include gene sequencing and look at the entire genome instead of just one or two genes. Yet while some findings are clear-cut — a gene for colon cancer, for example, will greatly increase the disease risk in anyone who inherits it — more often the significance of a genetic change is not so clear. Or, even if it is, there is nothing to be done.

Saturday, September 1, 2012

When The Chronicle published a confessional essay two years ago by a writer for a student-paper mill who had spent nearly a decade helping college students cheat on their assignments, it provoked anger, astonishment, and weary resignation.

The writer, under the pseudonym Ed Dante, said he had completed scores of papers for students who were too lazy or simply unprepared for their work at the undergraduate, master's, and doctoral levels.

The academic ghostwriter has retired, and in his new memoir, he reveals his true identity: Dave Tomar, 32, a graduate of the bachelor's program in communications at Rutgers University's New Brunswick campus and, now, a freelance writer in Philadelphia.

In The Shadow Scholar: How I Made a Living Helping College Kids Cheat, which is due out next month from Bloomsbury, Mr. Tomar seeks to cast himself as a millennial antihero while scolding colleges for placing the pursuit of money and status above student learning.